FY2022 NDAA: Mental Health Care

FY2022 NDAA: Mental Health Care

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INSIGHTi

FY2022 NDAA: Mental Health Care
Updated January 13, 2022
Background
Congress authorizes, through the annual National Defense Authorization Act (NDAA), Department of
Defense (DOD) mental health programs and services that support servicemembers, military retirees, and
their families. DOD administers many mental health programs that offer education; awareness; crisis
prevention resources; clinical treatment; nonclinical support and counseling services; and research and
development.
DOD has estimated that, from 2016 through 2020, 456,293 active duty servicemembers were diagnosed
with at least one mental health disorder. Mental health disorders also accounted for the highest number of
hospital bed days and were the second most common reason for outpatient visits among servicemembers.
During the same time period, the majority (64%) of mental health diagnoses were attributed to adjustment
disorders, anxiety disorders, and depressive disorders.
DOD has made numerous efforts to address the wide range of mental health issues, and potential
opportunities for improvement have been highlighted by the Government Accountability Office (GAO),
DOD Inspector General (DODIG), and other observers of military health. Table 1 lists the proposed and
enacted mental health-related provisions included in the FY2022 NDAA (P.L. 117-81).
Table 1. FY2022 NDAA Legislative Proposals
Senate Armed Services
House-Passed H.R. 4350
Committee-Reported S. 2792
Enacted Legislation (P.L. 117-81)
Section 702 would require the
No related provisions.
Section 701 adopts the House
TRICARE program to cover certain
provision with an amendment that
inpatient and outpatient health care
authorizes medically indicated
services to treat eating disorders
treatment of a servicemember with an
among servicemembers or their
eating disorder when listed as a
dependents. The provision would also
primary diagnosis.
require DOD to periodically screen
servicemembers for eating disorders.
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Senate Armed Services
House-Passed H.R. 4350
Committee-Reported S. 2792
Enacted Legislation (P.L. 117-81)
Section 714 would amend 10 U.S.C.
Section 704 adopts the House
§1090a to establish an additional
provision with an amendment that
process using a trigger phrase, by
assigns referral responsibilities to a
which a commanding officer or
commanding officer or supervisor in
supervisor confidentially refers a
the grade of E-5 or above.
servicemember for a mental health
evaluation.
Section 731 would require DOD, in
Not adopted.
col aboration with the Department of
State, to award grants to certain
entities for col aborative research with
Israeli institutions on post-traumatic
stress disorder.
Section 734 would require DOD to
Section 734 adopts the House
conduct a one-year pilot program that
provision with an amendment that
provides “direct assistance” with
requires DOD to expand the scope of
scheduling mental health appointments
the pilot program to include private
at certain military treatment facilities
sector care and to brief the Armed
(MTFs).
Services Committees within 90 days
after the program concludes.
Section 736 would authorize DOD to
Not adopted.
conduct a pilot program, by September
1, 2023, that surveys certain active
duty servicemembers on perceptions
of access to mental health care and
related stigma.
Section 739 would require the
Section 738 adopts the House
Secretary of Defense (SECDEF) to
provision with an amendment that
establish a committee to conduct an
requires the SECDEF to select at least
independent review of DOD’s suicide
one installation of each military
prevention and response programs.
department for independent review by
the committee.
Section 6480 would require the
Section 745 adopts the House
Military Services to submit a report to
provision with an amendment that
Congress on substance abuse disorder
requires the Under Secretary of
treatment concerns among
Defense for Personnel and Readiness
servicemembers and their dependents.
to brief the Armed Services
The provision would also require a
Committees on DOD’s substance
report to Congress on the use of
abuse policy, programs, and strategy.
substance abuse disorder treatment
programs on or near military
installations.
Source: CRS analysis of legislation.
Discussion
Mental Health Screening and Treatment
In August 2020, GAO found that while DOD does not generally screen servicemembers for eating
disorders during the annual periodic health assessment, “DOD is examining ways to improve its screening
of eating disorders in the military as well as identify possible ways to prevent such conditions in the

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military.” Section 701 of the enacted bill adopts House Section 702, which requires DOD to periodically
screen for, and treat, eating disorders among servicemembers. The provision also requires TRICARE to
cover certain medically-indicated outpatient and inpatient treatment services (e.g., residential services or
partial-hospitalization programs) for eating disorders, when listed as a primary diagnosis, for
servicemembers and their dependents.
DOD policy allows servicemembers to obtain a mental health evaluation on a voluntary (i.e., self-referral)
or involuntarily (i.e., command-directed) basis. Section 704 of the enacted bill adopts House Section 714,
requiring DOD to establish a new process that triggers a command-directed mental health evaluation. The
new process would allow a servicemember to disclose a certain phrase to a commanding officer or
supervisor (in the rank of E-5 or above) that then initiates an automatic, confidential referral for a mental
health evaluation.
A 2020 DOD Inspector General report found that the Department “did not consistently meet outpatient
mental health access to care standards for active duty service members and their families, in accordance
with law and applicable [DOD] policies.” Section 734 of the enacted bill adopts House Section 734. The
provision requires DOD to conduct a one-year pilot program that provides “direct assistance” to
beneficiaries scheduling mental health appointments at certain military treatment facilities or with certain
TRICARE providers. The provision also requires DOD to assess the program and provide an interim
briefing (180 days after enactment) and a final briefing (90 days after the program concludes) to the
Armed Services Committees on the program’s effectiveness and barriers to accessing mental health
appointments.
Mental Health Research
House Section 731, which was not adopted, would have directed the Secretary of Defense, in coordination
with the Secretary of State, to award grants for a period of no more than seven years to academic or
nonprofit entities for collaborative research between the United States and Israel on post-traumatic stress
disorder. In the Joint Explanatory Statement accompanying the FY2022 NDAA, the conferees stated that
a DOD briefing, received in March 2021, highlighted the “extensive military medical research
collaboration between Israel and the United States.” The conferees also noted that “this long-standing,
strong relationship is exemplified by the Shoresh Meeting, a biennial research conference led by the U.S.
Army and the Israel Defense Force (IDF) held since 1978.”
Program Assessments
Section 738 of the enacted bill adopts House Section 739. The provision requires the Secretary of Defense
to: (1) establish an independent committee to conduct a review of DOD’s suicide prevention and response
programs and (2) select at least one installation of each military department for review by the committee.
The committee is required to assess factors that contribute to military suicides and provide an initial (270
days after the committee is established) and final report (330 days after the committee is established) to
Congress on their findings.
Section 745 of the enacted bill adopts House Section 6480 with an amendment that requires the Under
Secretary of Defense for Personnel and Readiness to brief the Armed Services Committees on DOD’s
substance abuse policy, programs, and strategy.
House Section 736, which was not adopted, would have provided DOD an authority, through September
1, 2023, to survey servicemember perceptions of access and stigma related to mental health care in the
Military Health System. Servicemembers’ input would have been collected through the Defense
Organizational Climate Survey. The Joint Explanatory Statement stated that the conferees were
“concerned about the availability and access to mental health care services and the stigma associated

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seeking mental health care within the Department of Defense.” However, the conferees also noted that the
survey “already includes certain questions about access to mental health care and stigma, and a
requirement for additional questions for purposes other than measurement of command climate may be
problematic.”

Author Information

Bryce H. P. Mendez

Analyst in Defense Health Care Policy

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